Skip to main content
main-content
Top

04-05-2017 | Physical activity | Review | Article

Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis

Journal: Diabetes Therapy

Authors: JungHoon Lee, DoHoun Kim, ChangKeun Kim

Publisher: Springer Healthcare

share
SHARE

Abstract

Introduction

Type 2 diabetes (T2D) in elderly patients is associated with accelerated loss of skeletal muscle mass and strength. However, there are few meta-analysis reviews which investigate the effects of resistance training (RT) on glycemic control and skeletal muscle in the patients.

Methods

Three electronic databases were searched (from the earliest date available to November 2016). Studies were included according to the inclusion criteria: T2D patients at least 60 years old, fasting plasma glucose of at least 7.0, and at least 8 weeks of RT.

Results

Fifteen cohorts of eight studies (360 patients, average age 66 years) met the inclusion criteria. RT groups lowered glycosylated hemoglobin (HbA1c) (mean ES = −0.37, 95% CI = −0.55 to −0.20, P < 0.01) but did not result in a significant effect on lean body mass (LBM) (mean ES = 0.08, 95% CI = −0.15 to 0.30, P = 0.50). Homogeneity was shown between studies regarding HbA1c and LBM (Q = 15.70, df = 9, P = 0.07 and Q = 0.12, df = 4, P = 0.998, respectively). High-intensity subgroups showed a slight tendency to improve (rather than duration, frequency, and weekly volume) and to decrease HbA1c levels more than low-intensity subgroups (P = 0.37). RT increased muscular strength (mean ES = 1.05, 95% CI = 0.26–1.84, P = 0.01). No training components explained the heterogeneity between studies with changes in muscle strength.

Conclusion

RT improves glycemic control and muscle strength in elderly patients with T2D. RT with high intensity can be a strategy to treat patients with T2D and sarcopenia associated with aging.
Literature
1.
American Diabetes Association. National Diabetes Statistics Report. Estimates of diabetes and its burden in the epidemiologic estimation methods. Natl Diabetes Stat Rep. 2014;2014:2009–12.
2.
Coon PJ, Rogus EM, Drinkwater D, Muller DC, Goldberg AP. Role of body fat distribution in the decline in insulin sensitivity and glucose tolerance with age. J Clin Endocrinol Metab. 1992;75(4):1125–32. PubMed
3.
Gregg EW, Engelgau MM, Narayan V. Complications of diabetes in elderly people. BMJ. 2002;325:916–7.
4.
Park SW, Goodpaster BH, Strotmeyer ES, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes. 2006;55(6):1813–8. CrossRefPubMed
5.
Schwartz AV, Hillier TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25(10):1749–54. CrossRefPubMed
6.
Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–56. CrossRefPubMed
7.
Park SW, Goodpaster BH, Strotmeyer ES, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007;30(6):1507–12. CrossRefPubMed
8.
DeFronzo R. Pathogenesis of type 2 diabetes mellitus. Med Clin N Am. 2004;88(4):787–835. CrossRefPubMed
9.
Borghouts LB, Keizer H. Exercise and insulin sensitivity: a review. Int J Sports Med. 2000;21(1):1–12. CrossRefPubMed
10.
Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294–305. CrossRefPubMed
11.
Mourier A, Gautier JF, De Kerviler E, et al. Mobilization of visceral adipose tissue related to the improvement in insulin sensitivity in response to physical training in NIDDM. Effects of branched-chain amino acid supplements. Diabetes Care. 1997;20(3):385–91. CrossRefPubMed
12.
Venables MC, Jeukendrup AE. Aerobic training and obesity: effect on substrate metabolism and insulin sensitivity. Med Sci Sports Exerc. 2008;40(3):495–502. CrossRefPubMed
13.
Ibañez J, Izquierdo M, Argüelles I, et al. Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care. 2005;28(3):662–7. CrossRefPubMed
14.
Dreyer HC, Fujita S, Cadenas JG, Chinkes DL, Volpi E, Rasmussen BB. Resistance exercise increases AMPK activity and reduces 4E-BP1 phosphorylation and protein synthesis in human skeletal muscle. J Physiol. 2006;576(Pt 2):613–24. CrossRefPubMedPubMedCentral
15.
Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002;25(12):2335–41. CrossRefPubMed
16.
Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh M, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30. CrossRefPubMed
17.
Cauza E, Hanusch-Enserer U, Strasser B, et al. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil. 2005;86(8):1527–33. CrossRefPubMed
18.
Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353–5. CrossRefPubMed
19.
Cauza E, Strehblow C, Metz-Schimmerl S, et al. Effects of progressive strength training on muscle mass in type 2 diabetes mellitus patients determined by computed tomography. Wien Med Wochenschr. 2009;159(5–6):141–7. CrossRefPubMed
20.
Umpierre D, Ribeiro PB, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56:242–51. CrossRefPubMed
21.
Yang Z, Scott CA, Mao C, Tang J, Farmer AJ. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014;44(4):487–99. CrossRefPubMed
22.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W-65–94. CrossRef
23.
Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE. Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract. 2008;79(3):405–11. CrossRefPubMed
24.
Srinivas-Shankar U, Roberts SA, Connolly MJ, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010;95(2):639–50. CrossRefPubMed
25.
Cochran WG. Some methods for strengthening the common χ 2 tests. Biometrics. 1954;10(4):417–51. CrossRef
26.
Cohen J. Statistical power analysis for the behavioral sciences (rev. ed.). Hillsdale: Lawrence Erlbaum Associates; 1988.
27.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. CrossRefPubMedPubMedCentral
28.
Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002;25:1729–36. CrossRefPubMed
29.
Honkola A, Forsén T, Eriksson J. Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol. 1997;34:245–8. CrossRefPubMed
30.
Baldi JC, Snowling N. Resistance training improves glycaemic control in obese type 2 diabetic men. Int J Sports Med. 2003;24(6):419–23. CrossRefPubMed
31.
de Lade CG, Marins JC, Lima LM, et al. Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes. Diabetol Metab Syndr. 2016;8(13):1–9.
32.
Fenicchia LM, Kanaley JA, Azevedo JL, et al. Influence of resistance exercise training on glucose control in women with type 2 diabetes. Metabolism. 2004;55(3):284–9. CrossRef
33.
Cauza E, Hanusch-Enserer U, Strasser B, et al. The metabolic effects of long term exercise in type 2 diabetes patients. Wien Med Wochenschr. 2006;156:515–9. CrossRefPubMed
34.
Dunstan DW, Daly RM, Owen N, et al. Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care. 2005;28(1):3–9. CrossRefPubMed
35.
Simpson KA, Mavros Y, Kay S, et al. Graded resistance exercise and type 2 diabetes in older adults (the GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial. Trials. 2015;16:512. CrossRefPubMedPubMedCentral
36.
Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci. 2012;67(11):1259–65. CrossRefPubMed
37.
Daly RM, Miller EG, Dunstan DW, et al. The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized controlled trial. Trials. 2014;15:431. CrossRefPubMedPubMedCentral
38.
Park SP, Lee IH. Effects on training and detraining on physical function, control of diabetes and anthropometrics in type 2 diabetes; a randomized controlled trial. Physiother Theory Pract. 2015;31(2):83–8. CrossRefPubMed
39.
Tan S, Li W, Wang J. Effects of six months of combined aerobic and resistance training for elderly patients with a long history of type 2 diabetes. J Sports Sci Med. 2012;11(3):495–501. PubMedPubMedCentral
40.
Gordon BA, Bird SR, MacIsaac RJ, Benson AC. Does a single bout of resistance or aerobic exercise after insulin dose reduction modulate glycaemic control in type 2 diabetes? A randomised cross-over trial. J Sci Med Sport. 2016;19(10):795–9. CrossRefPubMed
41.
Heden TD, Winn NC, Mari A, et al. Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. J Appl Physiol. 2015;118(5):624–34. CrossRefPubMed
42.
Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care. 2013;36(8):2372–9. CrossRefPubMedPubMedCentral
43.
Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci. 2006;4(1):19–27. PubMedPubMedCentral
44.
Kadoglou NP, Fotiadis G, Athanasiadou Z, Vitta I, Lampropoulos S, Vrabas IS. The effects of resistance training on ApoB/ApoA-I ratio, Lp(a) and inflammatory markers in patients with type 2 diabetes. Endocrine. 2012;42(3):561–9. CrossRefPubMed
45.
Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62. CrossRefPubMedPubMedCentral
46.
Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147:357–69. CrossRefPubMed
47.
Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9. CrossRefPubMed
48.
Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract. 2009;83(2):157–75. CrossRefPubMed
49.
Irvine C, Taylor NF. Progressive resistance exercise improves glycaemic control in people with type 2 diabetes mellitus: a systematic review. Aust J Physiother. 2009;55(4):237–46. CrossRefPubMed
50.
Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226–37. CrossRefPubMedPubMedCentral
51.
Schuller G, Linke A. Diabetes, exercise. In: Goldstein B, Muller-Wieland D, editors. Type 2 diabetes: principles, practice. New York: Informa Healthcare; 2008. Chap 6.
52.
Miller WJ, Sherman WM, Ivy JL. Effect of strength training on glucose tolerance and post-glucose insulin response. Med Sci Sports Exerc. 1984;16:539–43. PubMed
53.
Evans WJ. Effects of exercise on body composition and functional capacity of the elderly. J Gerontol A Biol Sci Med Sci. 1995;50A:147–50. CrossRef
54.
Fielding RA. The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly. J Am Coll Nutr. 1995;14:587–94. CrossRefPubMed
55.
Tarnopolsky MA. Mitochondrial DNA shifting in older adults following resistance exercise training. Appl Physiol Nutr Metab. 2009;34:348–54. CrossRefPubMed
56.
Tzankoff SP, Norris AH. Effect of muscle mass decrease on agerelated BMR changes. J Appl Physiol. 1977;43:1001–6. PubMed
57.
DeFronzo RA, Ferrannini E, Sato Y, Felig P, Wahren J. Synergistic interaction between exercise and insulin on peripheral glucose uptake. J Clin Investig. 1981;68:1468–74. CrossRefPubMedPubMedCentral
58.
Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26:2977–82. CrossRefPubMed
59.
Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011;43(2):249–58. CrossRefPubMedPubMedCentral
60.
Zierath JR, Krook A, Wallberg-Henriksson H. Insulin action and insulin resistance in human skeletal muscle. Diabetologia. 2000;43:821–35. CrossRefPubMed
61.
Terada S, Yokozeki T, Kawanaka K, et al. Effects of high-intensity swimming training on GLUT-4 and glucose transport activity in rat skeletal muscle. J Appl Physiol. 2001;90(6):2019–24. PubMed
62.
Tabata I, Suzuki Y, Fukunaga T, Yokozeki T, Akima H, Funato K. Resistance training affects GLUT-4 content in skeletal muscle of humans after 19 days of head-down bed rest. J Appl Physiol. 1999;86:909–14. CrossRefPubMed
63.
Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Investig. 2002;32(Suppl 3):14–23. CrossRef
64.
Hurley B, Hagberg JM. Optimizing health in older persons: aerobic or strength training? Exerc Sports Sci Rev. 1998;26:61–89. CrossRef
65.
Taylor N, Dodd K, Shields N, Bruder A. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002–2005. Aust J Physiother. 2007;53:7–16. CrossRefPubMed
66.
Snowling N, Hopkins W. Effects of different modes of exercise training on glucose control, risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care. 2006;29:2518–27. CrossRefPubMed
67.
Poehlman ET, Dvorak RV, de Nino WF, Brochu M, Ades PA. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a randomized controlled trial. J Clin Endocrinol Metab. 2000;85:2463–8. PubMed
68.
Plowman SA, Smith DL. Exercise physiology for health, fitness, and performance. 2nd ed. San Francisco: Benjamin Cummings; 2007.
69.
Dela F, Kjaer M. Resistance training, insulin sensitivity and muscle function in the elderly. Essays Biochem. 2006;42:75–88. CrossRefPubMed
70.
Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004;27(10):2518–39. CrossRefPubMed
71.
Lindle RS, Metter EJ, Lynch NA, et al. Age and gender comparisons of muscle strength in 654 women and men aged 20–93 yr. J Appl Physiol. 1997;83(5):1581–7. PubMed
72.
Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–63. CrossRefPubMed
73.
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878–86. CrossRefPubMed
74.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–92. CrossRefPubMedPubMedCentral

New additions to the Adis Journal Club

A selection of topical peer-reviewed articles from the Adis journals, curated by the editors.

ADA 2022 coverage

Access the latest news and expert insight from the ADA 82nd Scientific Sessions